Rehabilitation After Fracture

By Alain Michelotti (Physiotherapist & Chiropractor)

Breaking a bone is a relatively common type of injury. From falls to car accidents and sport injuries, there are many ways to damage and fracture our framework. For an uncomplicated break a period of immobilisation in a cast (usually six weeks) is generally enough to allow the bone to heal. If the break is more serious, surgery may be necessary to reconstruct the bone and stabilize the fracture. This is usually done using plates and screws. The severity of a fracture will also depend on where it takes place. Breaking a bone near a joint (shoulder, elbow, wrist, hip, knee and ankle) will be considered to be more serious than breaking it at a distance from a joint. This is because joints are complicated structures allowing bones to move in relation to each other. Damaging a joint and having to immobilise it for weeks to allow the healing process to take place can have long term consequences on its function.

Joints are not the only structures to suffer from a period of immobilisation, muscles will waste away. This is why it is important that during the time a splint, a brace or a plaster cast is worn the parts of the limb which are not immobilised should be moved. This will fight muscle wasting and increase blood supply in the area. For example, if your plaster leaves your fingers or your toes free, it is important to move them. Studies have even suggested that just imagining exercising can delay muscle wasting by creating stronger connections between the brain and the muscles.

In most cases, 6 to 8 weeks of immobilisation is sufficient for bones to heal and as soon as the plaster is removed the period of rehabilitation must start without delay.

This is when the physiotherapist will (or should) appear on the scene. Being given a sheet of exercises is very useful but not necessarily enough to enable you to recover quickly and completely and it is at that point that too little and too late may create problems for the future. The first stage of the rehabilitation process should address the loss of mobility of the part of the limb which has been affected by the fracture. To achieve this, the joint must be gradually and passively mobilised to allow it to recover whatever mobility it has lost. It is at this point that the expression “no pain, no gain” becomes significant.

Although the exercise sheet will tell you what to do, it will not answer questions like: “How far should I go?”, “Should I go through the pain barrier and, if so, how far and for how long?”, “Do I run the risk of breaking the bone again if I overdo it?” It is at this stage that an assessment followed by some extra physiotherapy sessions may prove useful. To save time and money it is sometimes possible for the physiotherapist to train a relative who can become a kind of “home rehabilitation assistant”. With mobile phones it is easy to film a rehabilitation session and this provides both the patient and the helper with some extra guidance. Once maximum mobility has been restored, recovering muscle strength is going to be much easier and is usually only a question of time and repetitive exercises. If you think you need some help with your rehabilitation after a fracture, you can always contact us for some physiotherapy advice and guidance.